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08030163 (2) CITY OF CUPERTINOa+t'...E4S "' ° '''^ BUILDINoolvlsloN. PERMIT CUNT°RACTORI140. IFORMATIt3 BUIL Y44'WMZINGW00D AVE WOERTINK ELECTRIC P08030163 ER'S NAME: PERMIT ISSUE DATE ERIC S WU 6072 MCABEE RD 03/27/2008 PHONE: SANITARY NO. CONTROL NO. (408) 813-2866 ARCHITELTIENGINEEW BUILDING PERMIT INFO 'BLDG II PLUMB MECH LICENSED CONTRACTOR'S DECLARATION W enceJob Description F 1 herby affirm h I are licd under provWona of Chapter 9(mmOE:SCrIPm casms � 4 with section 7")of Division 3ofMeBusiness ats R. 'uruCd licenWb FROM 100 AMP TO 200 AMP METER/MAIN CHANGE UPGRADE EE in full forte and ef( oV License s Lie N Dak 2p jU ARCHf1EC1'E DECLA TON 1 u derwnJ my pans shall be used uutl an u public mcnrN DyU e ted Licensed Professional h OWNER-BUILDER DECLARATION ME I hemby starts Nat I am exempt from the Canaactoes license Law for Ne , i o o relieving maven.(Section 7031.5.Business Ind Pmfrsaions Code:Any city or county S 9 which requires a permit to construct.ales.improve,detsalbb,or repair any structure t�, prior b its issuanWm issuance,Man ekes the applicant for web permit to file aalgned statement z< hhm be b licensed pursuant W the previsions of Me Contractor's License Law(Chapter 9 Sq.Ft. Floor Area 2000 Valuation Ca (commencing with Section 70M)of Division 7 of the Business and Prowwons Code)or 3 that he is exempt Nuefe m and Ne bub fm Ne alleged assumption.Any violadan of Section 7031.5 by any.pplksntfar a Permit subjects the applicant to a civil penalty atNumber QQQU not mart tum five hundred dollars(SM 3 6 917 011 A(ff Occupancy ZYPe 0 1,as ovmr of the property,or my employers with wages as Neo ane compensation, will do was work.and Wstructure b net intended or offered forule(Sm.7144,Business Required Inspections most Prowask.Code:The Can actor's License Law does not apply W an..of q P property who builds or impmves theroon.and who does such work himself or through his own empwyeos,provided that web improvements tee not intended or offered for We.9. however,Ne building or Improvement Is sold within one year of completion.the owner. Wilde' win love also burden of proving that the did not build or improve for purpose of tela). Cl 1.u owner of the PmNny,am exclusively contracting with limned cenuactws W mNQI the Project(Sec.70d4,Business SM Professions Cede)The C°uvaee's U. cute Law dean not apply u an owner of property who builds or improves thenen,and, who contracts for such projects with arnmract°ra)licensed pursuant W the Conlracmfs Lkense law. 0 l am exempt under Be, .B k P C for Ws name 40 civ Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury arc of to fallowing deelantions: ❑Ihsveand will meinWne Grtfinw of Cement to eel!-insure fa Worker's Compen- " anion,an Pmvidcd far by Section 77x0 of the lobos Cotler.ra to pmfarmance of Ne weh fa which Nis permit it issued. 0 I have and will maintain Workees Compensation Insursnce,u acquired by Section 770Da1 the Labos Codc.far the performanceor the wank for which this Permit is Issued - My We {pg".a bounce,caniu and Poliry�w,sro/be am: / , Grtier. ./ Polis,Na:✓✓ `B CERTIFICA •OFEKEMPI70N FROM WORKERS' COMPENSATION INSURANCE (Ohascalon hued mabecanphued If the lennih In tura.hundred dollars(SIM) nr lana) , 1 certify Nat m We i ufmmmen of the work for which this permit is Issued.l"1 hent employ any person In any manrcran u W hccetsa subject W Me Workers'Compensation LA"of GIIf(ML DIW Applicant NOTICE TO APPLICANT.If,after making this ConlEcew of Esemptiar,you should bmome subject W the Wedwr's Campcandu m provisions of Me .Wu "We' you mute .JO forthwith comply with such Provisions or this permit shall W deemed my°ked. Z r CONSTRUCITON LENDING AGENCY F+sN.. I hereby affirm that Nen I..c°nstrawme lending sports,for the Performance of a the work for which this Permit Is issued(Sec.7097.Cl,C.) I27 Q UndieYs Nem. Z Landeh Addrtss U Q 1 certify that I have read this application and sue that the shove Information Is ty comet.1 name to comply with all city and county oNinarman and saw laws relating to 0 building construction.and hereby authorice repreacnutives of this city W cmc upon the W alinve-mentimted property for inspection purposes gy (We)agree W save,indemnify and keep harmless the City of Cupertino against y Iiabillticajolgtsens,com and expenses which may in anyway acertte gsinst said City U'Z ie COrts[()uehhe.of Ne ran" g of NL1 It. ^' APPLICANT U NOB 0 1 L MPLY ALL N N-PO Issued by: Date / BOURCE REG �y S Re-roofs Signuum f t C Oa ' HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wildinode. cuPantsWma MMle haurdo materiJ Is de0ned by Ne Cupertino Munici Chapter 9.12,and the Health and Safes, ode, ❑Yu o Section zs5715532a)? All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future b uuildin apart taw equlpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hurdous air conuminana u de d by don Bay Arta Air Quality Management all new materials for inspection. Disticft 0 Yns o Ihaveread NeharaNmamucrindsnqulremenup�dor Cha m6.95ofMaCalifn- nbHcalNzSectyC�_ ote25505..33SS577 d 67<.I�undtmdon rot cnn�(ia fey p hilityt d y Ne aav t Ne y� (aSignature of Applicant Date Owner % te. All roof coverings to be Class'W'or better • CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36917011. 00 DATE ISSUED. . . . . . . : 03/27/2008 RECEIPT #. . . . . . . . . : BS000004289 REFERENCE ID # . . . : 08030163 SITE ADDRESS . . . . . : 934 BLAZINGWOOD AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ERIC S WU ADDRESS . . . . . . . . . . : 934 BLAZINGWOOD AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4619 RECEIVED FROM . . . . . CONTRACTOR . . . . . . . : ALAN WOERTINK LIC # 28441 COMPANY . . . . . . . . . . : WOERTINK ELECTRIC ADDRESS . . . . . . . . . . : 6072 MCABEE RD • CITY/STATE/ZIP SAN JOSE, CA 95120 TELEPHONE . (408) 813-2866 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 2, 000. 00 0.50 0 . 00 0 . 50 0. 00 1ELECINSP HOUR 1. 00 122 .38 0 . 00 122 .38 0. 00 1EPERMITFE FLAT RATE 1. 00 40 .79 0 . 00 40.79 0. 00 ITRAVDOC FLAT RATE 1. 00 40. 79 0 .00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 204 . 46 0. 00 204.46 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 204 .46 VISA --------------- TOTAL RECEIPT 204 .46 • INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE • CITY OF CUPERTINO PERMIT INVOICE OPERATOR: SylviaM Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36917011. 00 INVOICE DATE. : . . . . : 03/27/2008 REFERENCE ID # . . . : 08030163 SITE ADDRESS . . . . . : 934 BLAZINGWOOD AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ERIC S WU ADDRESS . . . . . . . . . . : 934 BLAZINGWOOD AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4619 CONTRACTOR . . . . . . . : ALAN WOERTINK LIC # 28441 COMPANY . . . . . . . . . . : WOERTINK ELECTRIC ADDRESS . . . . . . . . . . : ' 6072 MCABEE RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95120 TELEPHONE . . . . . . . . : (408) 813-2866 ® FEE DESCRIPTION----------- DUE FOR---- AMOUNT DUE PAID BALANCE ---------- ---------- ---------- SEISMIC RESIDENTIAL PRINTING PERMIT 0 .50 0. 00 0. 50 OTHER ELECTRICAL INSPECTION PRINTING PERMIT 122 .38 0. 00 122 . 38 ELEC PERMIT ISSUANCE PRINTING PERMIT 40 .79 0 . 00 40 .79 TRAVEL & DOCUMENTATION FEE PRINTING PERMIT 40 .79 0. 00 40 .79 ------ ---------- ---------- 204 .46 0 . 00 204 .46 • CITY OF CUPERTINO cUPEkTiNO GENERAL BUILDING PERMIT APPLICATION FORM ��G3D/ls3 APN# 3 . Qo Date: 31,e2 7 �al Building Address: �3 61 ��i�/ovo Mailing Address (if different from building address): Owner's Name: Phone#: oo� Contractor: /D„,yf/ Phone :�GT e13 66, Fax: DO 79 057. Contractor License#: �p o 5 cf • Cupertino Business License#: *v Contact: . / � J� ��„l� Phone: V Fax: Residential Commercial ❑ Job Description: Building Permit Info: Bldg ❑ Elect (� Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: } 1 FR, 11FR E] 11, 111, V-lHR [—] 11, 111, 1V V-N � � Valuation: 2d o a Square Footage: • Project Size: Standard 0 Large 0 Major ❑ CITY OF CUPERTINO CUPERTINO GENERAL BUILDING • PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1BTEMPPER Temporary Building Permit (good for B 30 days) IBBOILERI For the installation or relocation of ea M boiler/compressor to &including 3 horsepower, or ea absorption sys to &. incl 100,000 Btu/h 29.3kw) 1BBOILER2 Installation /relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption sys over 100,000 Btu/h 1BBOILER3 Installation/relocation of ea M boiler/compressor over 15 horsepower to &incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h IBBOILER4 Installation/relocation of ea M boiler/compressor over 30 bosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h 1BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h IBAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. r IELECINSP Other Electrical Inspections (per hour) E t 1MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing & Gas Inspections P (per hour IMEETINGIHR Application Meeting B CITY OF CUPERTINO CUPEt�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/DuplexNew B lACOUSRESAD SFDWL/Duplex-Addition/Alteration B lACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1CHIMNEY Chimney B 1CHIMNEYR Chimney Repair B FENCES 1FENCE>6FT Non-masonry, over 6 ft in height B 1FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1FIREPLMAS Fireplace Masonry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B 1FLAGPOL>20 Flag pole (over 20 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRIV Pile Foundation Driven(steel,pre- B stressed concrete 3 of 5 CITY OF CUPERTINO CUPEf�TINO GENERAL BUILDING APPLICATION O FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM RETAINING WALUCONCRETE OR MASONRY) 1RETSTN Standard (up to 50 ft) B 1RETSP310 Special Design, 3-10' high (up to 50 `) B 1RETSPIO Special Design, over 10' high (up to B 50' 1RETCRB< Gravity/Crib Wall, 0-1O'high(up to B 50 ft 1RETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft SIDING 1SIDEST/BK Siding, Stone &Brick Veneer B (interior/exterior 1SIDEOTHER Siding all other B SKYLIGHTS 1SKYL<10 SF Skylight less than 10 sf B 1 SKYL>1 OSF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st 1STUCOAP Stucco Applications (up to 400 so B additional stucco application 4 of 5 i CITY OF CUPERTINO N GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group ]GENRES or 1GENCOM 1 WINREP Replacement windows/sliding glass B door ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry includes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1ELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M 1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P ISTPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B 5 of 5 i Community Development 10300 Torre Avenue 411 ! 2 J Cupertino CA 95014 Telephone(408)777-3228 UPEkTINO Fax(408) 777-3333 Building De artment JOB ADDRESS: �� � PERMIT # OWNER'S NAME: ( PHONE # GENERAL CONTRACTOR: FAX I am not using any subcontractors: 143 7 Signature D to Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical r Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile - ZA LI Aie 7168 er/ ontra for Signature Pfate